MEDICARE: JAMES S WADDELL DC PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111N00000X	Chiropractor	CE004436	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467657585
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMES S WADDELL DC PC

Provider Business Mailing Address
First Line	:	6716 N OAK TRFY
Second Line	:
City	:	GLADSTONE
State	:	MO
Zip	:	64118-3345
Country	:	US
Telephone Number	:	816-436-7158
Fax Number	:

Provider Business Practice Location Address
First Line	:	6716 N OAK TRAFFICWAY
Second Line	:
City	:	GLADSTONE
State	:	MO
Zip	:	64118-3345
Country	:	US
Telephone Number	:	816-436-7158
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JAMES STEVEN WADDELL
Credential	:	D.C.
Telephone Number	:	816-436-7153

Provider Enumeration Date	:	06/19/2007
Last Update Date	:	10/05/2010

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